We typically associate incontinence with a lack of muscle tone of the pelvic floor or sometimes with bacterial infection. But what if the bladder microbiota and urinary incontinence are linked?

I have explored the role of the urinary microbiota in previous posts (here and here) and how an imbalance in microbes known as ‘dysbiosis’ can play a role in different bladder conditions. One of them is urgency incontinence.

It sounds weird but there is evidence suggesting that even incontinence can be related to the microbes living in our bladder.

This applies specifically to urgency urinary incontinence.

What is Urgency Urinary Incontinence?

Urgency urinary incontinence is a problem that affects millions of men and women worldwide and poses a substantial economic burden on healthcare systems [1].

It is the involuntary leaking of urine due to a sudden intense urgency of needing to pass urine that often doesn’t leave enough time to get to a toilet.

The Urinary Microbiota in People with Incontinence

As I’ve discussed in my previous articles about the urinary microbiota, we still don’t know for sure what a healthy urinary microbiota looks like.

However, changes have been discovered in people suffering from different bladder conditions.

Maybe the kind of change in microbes even determines the kind of bladder condition a person will suffer from? A lot of work still needs to be done in this field.

What we do know is that there is a change in the urinary microbiota in people suffering from urgency incontinence compared to healthy people.

Two studies have looked at this phenomenon [2, 3].

The bladder microbiota is normally dominated by the genus Lactobacillus and the most important microbe for bladder health seems to be Lactobacillus crispatus [2].

The bacterial population was dominated by Lactobacillus in both healthy people and people with urgency incontinence. However, there was a reduction in the diversity of the different types of Lactobacillus present in the urinary incontinence sufferers.

Lactobacillus gasseri was found to be more dominant in urinary incontinence sufferers.

Another genus that was abundant in both healthy people and sufferers was Gardnerella. It was increased in the urgency incontinence sufferers, however.

Gardnerella vaginalis can cause bacterial vaginosis if it overgrowth in the vagina.

Other genera that were also more frequently found in people with urgency incontinence were Actinobaculum, Actinomyces, Aerococcus, Arthrobacter, Corynebacterium, Gardnerella, Oligella, Staphylococcus, and Streptococcus.

Some of these contain pathogens known to be able to cause infections (although none are usually detected on standard tests).

Diversity and severity of Symptoms

The overall diversity of bacteria in the bladder may have an impact on the severity of symptoms.

One study found that those urgency incontinence sufferers with a lower diversity of microbial species had worse symptoms and more incontinence episodes [3]. The worse the symptoms, the lower the diversity.

Decreased microbial diversity in other places of the body (such as the gut) has been linked with disease states.

Another study contradicts this, however. It found that lower diversity was associated with less symptoms and a better response to the urgency incontinence medication ‘Solifenacin’ [4].

Balance is the Key

Several of the bacteria that were more abundant in urgency incontinence bladders can also be found in healthy people.

The problem seems to be when a state of ‘dysbiosis’ arises – an imbalance of bacteria, where normally harmless bacteria can overgrow and cause problems.

Therefore, the best strategy is probably not to just randomly kill off all bacteria, but to restore balance of the microbiome, or create a ‘symbiosis’.

Just another Infection?

The scientific evidence suggests that urgency incontinence may not be a mechanical problem per se but that low grade infection may play a role.

A lot of the microbes that are potentially responsible cannot yet be identified by standard urine testing.

As a former long-term sufferer of chronic UTIs and interstitial cystitis I have also experience low-level incontinence, although it was never embarrassingly bed. But this problem has improved with efforts to restore my microbial balance.

Have you got chronic UTIs or interstitial cystitis? Do you also experience urgency incontinence? How does it affect your life?



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Sources

1. Milsom, I. et al Global prevalence and economic burden of urgency urinary incontinence: a systematic review Eur Urol. 2014 [Jan;65(1):79-95] Abstract available at: https://www.ncbi.nlm.nih.gov/pubmed/24007713
2. Pearce, Meghan M. et al The Female Urinary Microbiome: a Comparison of Women with and without Urgency Urinary Incontinence 2014 [Jul-Aug; 5(4): e01283-14.] available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161260/
3. Karstens, Lisa Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity? Front Cell Infect Microbiol. 2016; 6: 78. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961701/
4. Thomas-White, KJ et al Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016 May;27(5):723-33. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26423260